Objectives: The purpose of the study was to investigate the aetiology, risk factors, clinical features and outcome of infective endocarditis (IE) in the area of Crete.

Methods: The medical records of all patients hospitalised at the University Hospital of Heraklion, Crete, Greece, diagnosed with IE from 1993 to 2007 were retrospectively reviewed. All patients who met the modified Duke criteria for definite IE, were included.

Results: Fifty four cases of definite IE occurring in the same number of patients were evaluated. The median age of patients was 60 years (range 4674). There were 35 males (64%). Transthoracic echocardiography (TTE) was performed in 37 patients (68%), and transoesophageal (TEE) in 19 (35%). Findings consistent with endocarditis were found in 32 (86%) out of 37 TTE and in 16 (84%) out of 19 TEE. Most cases [41 patients (76%)] were native valve IE. Predisposing conditions were evident in 40 patients (74%) and included prosthetic valve [13 patients (24%)], injected drug use [1 (1.8%)], mitral valve prolapse [6 (11%)], poor dental hygiene [3 (5%)], diabetes [10 (18.5%)] and HIV infection[1 (1.8%)]. The mitral valve was affected in 26 patients (48%), the aortic in 22 (40%), while 6 (11%) had both valves affected. Blood cultures were negative in 8 cases (15%). The leading causative microorganism was S. aureus isolated in 15 cases (28%), followed by coagulase-negative staphylococci in 12 (22%), viridans streptococci in 9 (16.6%) and E. faecalis in 5 (9%). A number of rare and difficult to treat microorganisms had been identified such as G. morbillorum in 2 (4%) cases, S. lugdunensis in 2 (4%), Brucella spp in 1 (2%), and S. pneumoniae in 1 (2%). One patient had positive serologic test for C. burnettii (2%). All patients received antimicrobial treatment on empirical basis, which was proven appropriate in 43 patients (93%) based on the results of blood cultures. Seven patients (12%) had surgical treatment. In-hospital mortality reached 15% (8 patients).

Conclusions:Staphylococcus and Streptococcus spp remained the most common aetiologic agents of IE. However, the presence of uncommon and/or difficult to treat pathogens raise concern that appropriate prophylaxis and empirical treatment may be more complicated than believed in the past. Furthermore serology for C. burnettii should be included in the diagnostic work-up in endemic areas.

Session Details

Date:

16/05/2009

Time:

00:00-00:00

Session name:

19th European Congress of Clinical Microbiology and Infectious Diseases